Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mistakes > Bear the Children > Flashcards

Bear the Children Flashcards

1
Q

What can cause a false VDRL positive?

A

Antiphospholipid Antibody Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Young pregnant patient with previous miscarriages, positive VDRL & negative FTA-ABS

A

Previous miscarriages make you think Lupus
Negative FTA-ABS makes syphilis much less likely
The VDRL positive could be from Antiphospholipid

Common findings include clots, thrombocytopenia & prolonged aPTT.

Start on LMWH to reduce risk to current pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Timeline of Postpartum Blues

A

Onset of 2 - 3 days postpartum
Resolves within 2 weeks

Treatment: Reassurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Timeline of Postpartum Depression

A

Onset typically 4 - 6 weeks postpartum (but can start anytime within the first year)

Lasts longer than 2 weeks

Treat with SSRIs and/or psychotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which SSRI is preferred in postpartum depression?

A

Sertraline (infant serum levels are undetectable, even with breastfeeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hyperandrogenism during pregnancy is caused by

A

Ovarian masses

Luteoma
Theca Luteum Cyst
Krukenberg Tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

African American pregnant patient with new-onset hirsutism & acne

A

Luteoma
Yellow or yellow-brown mass (often with areas of hemorrhage) of large lutein cells
Appears as solid ovarian mass (bilateral in half patients)

Benign
Puts female fetus at high risk of virilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment of Luteoma

A 
Clinical monitoring (w/ ultrasound)
Mass effect (hydronephrosis, obstructive labor, ovarian torsion) rare but nonzero risk. Surgery if so.
Symptoms regress spontaneously after delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

New onset solid ovarian mass in pregnancy

A

Luteoma

OR

Krukenberg Tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Krukenberg Tumor

A

Metastasis from primary GI cancer

Should present with other oncologic symptoms (weight loss, abdominal pain, etc)
Solid ovarian mass on ultrasound
Presents with hyperandrogenism
Female fetus at high risk of virilization

Biopsy & surgery indicated if malignancy is suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

New onset multi-sepatated ovarian mass in pregnancy

A

Theca Lutein Cyst

Can be asymptomatic or cause hyperandrogenism (less likely)
Arises from high beta-hCG levels (molar or multip)

If complete hydatidiform mole, suction curettage
Theca Lutein Cyst will regress spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

On TVUS:
Central heterogeneous mass
Numerous discrete anechoic spaces

A

Complete Hydatidiform Mole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hyperemesis gravidarum

Bilaterally enlarged ovaries

A

Concerning for complete hydatidiform mole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does a complete hydatidiform mole form?

A

Abnormal fertilization of empty ovum by 2 sperm

OR

Fertilization by 1 sperm that duplicates its genome

Leads to crazy high beta-hCG
Leads to hyperstimulation of ovaries and Theca Lutein Cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Main risk side effect of epidural anesthesia

A

Hypotension (occurs in 10% of epidurals)

Sympathetic nerves responsible for vascular tone are blocked
Vasodilation ensues, which can lead to venous pooling & hypotension
Complication can be fetal acidosis from hypoperfusion

Prevent with aggressive IV fluid volume expansion beforehand
Treat by placing mom on her Left side, give IV fluids and/or pressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Rare side effect of epidural anesthesia in a high spinal or a total spinal

A

Depression of cervical spinal cord & brainstem activity

First signs:
Hypotension
Bradycardia
Respiratory difficulty

Late signs:
Diaphragmatic paralysis
Cardiopulmonary arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pregnant patient receives epidural during delivery

Develops postural headache postpartum (worse sitting up, better lying down)

A

Dura was inadvertently punctured (“wet tap”)

Spinal fluid is leaking out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Definition of PPROM

A

Rupture of membranes < 37w

Some patients experience gush
Others experience intermittent leakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Nitrazine-Positive

A

It is amniotic fluid, not urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

PPROM at >= 34w

A

Deliver

M&M associated with premature delivery decreases at 34w
Chorioamnionitis is bad news
Give intrapartum IV Penicillin if GBS status is unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PPROM at < 34w w/ signs of infection (maternal fever, fetal tachycardia) or fetal compromise

A

Deliver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

First line therapy for stress incontinence in pregnancy

A

Kegels

Pessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Elevated Maternal Serum AFP at 15 - 20 weeks

A

Open neural tube defects:
Anencephaly
Open spina bifida

Ventral wall defects:
Omphalocele
Gastroschisis

Multiple gestation

Rare:
Fetal congenital nephrosis
Benign obstructive uropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Decreased Maternal Serum AFP at 15 - 20 weeks

A

Aneuploidies:
Trisomy 18
Trisomy 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Diagnosis of CF

A

Genetic testing of parents

If both parents are carriers:
CVS, Amniocentesis or fetal blood sampling can confirm

AFP is not affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Maternal causes of elevated AFP

A

Hepatocellular Carcinoma
Gonadal Tumors
Liver Disease (Acute or chronic viral hepatitis)

Only suspect these if mom is symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What causes Trisomy 18?

A

Meiotic Nondisjunction (usually)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What causes Trisomy 21?

A

Meiotic Nondisjunction or Robertsonian Translocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Low Maternal Serum AFP
Low estriol
High beta-hCG
High Inhibin A

A

Trisomy 21

Down Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Low Maternal Serum AFP
Very Low Estriol
Very Low beta-hCG
Normal Inhibin A

A

Trisomy 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Asymmetric Moro Reflex
Pain with passive motion of affected extremity
Crepitus over affected clavicle

A

Displaced clavicular fracture

Heals spontaneously in 7 - 10 days w/o sequelae
Treatment = reassurance & guidance on gentle handling
Pinning infant’s sleeve to shirt can reduce motion and decrease pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Why do we avoid Aspirin in infants?

A

To avoid Reye syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Nonblanching blue-grey patches

A

Mongolian Spots

Benign, common in dark-skinned infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Routine Prenatal Labs - Initial Visit

A 
Rh (D) type, Ab screen
H&amp;H / MCV
HIV, VDRL/RPR, HbSAg
Rubella &amp; Varicella Titers
Pap (if screening indicated)
Chlamydia PCR
UCx
Urine Protein

HbA1C or OGTT if mom is at risk for undiagnosed DMII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Routine Prenatal Labs - 24 - 28 weeks

A

H&H
Ab Screen (if Rh Neg)
50g 1h GCT

Repeat HbSAg & Chlamydia PCR if mom is high risk (IVDU, STIs earlier in pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Routine Prenatal labs - 35 - 37 weeks

A

GBS Cx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Risk factors for gestational diabetes

A

Obesity
Excessive weight gain during pregnancy
Family history of DM
Previous macrosomic infant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When do we give Rhogam?

A 
28 - 32w normal gestation
<72h after delivery of Rh+ infant
<72h after Spontaneous Abortion
Ectopic pregnancy
Threatened abortion
Hydatidiform mole
CVS, Amniocentesis
Abdominal trauma
2nd &amp; 3rd trimester bleeding
External cephalic version

Any occasion for mom to be exposed to fetal blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Rh(-) mom is sensitized and has elevated Ab titers already. Do we give Rhogam anyway?

A

No. Just monitor fetus closely for hemolytic disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Potential maternal complication of fetal demise

A

Coagulopathy after several weeks of fetal retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Fetal ASD in AMA mom is associated with

A

Trisomy 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Symmetric fetal growth restriction occurs when?

A

First trimester

Due to aneuploidy, congenital abnormalities or infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Asymmetric fetal growth restriction occurs when?

A

Second & third trimesters

Due to maternal conditions leading to placental insufficiency, such as hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Patient with placenta previa is at risk for

A

Painless but severe antepartum hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Guidelines for managing placenta previa

A

May resolve on its own as lower uterine segment grows

Pelvic rest & abstinence from intercourse are recommended.
Clinicians should refrain from digital examination of the cervix
Vaginal delivery is contraindicated
Cesarean delivery is scheduled for 36 - 37 weeks to avoid exposing patient to labor contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Indications for cerclage

A 
History of second-trimester deliveries
Short cervix (<2.5cm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If placenta previa resolves on its own, what is the patient still at risk for?

A

Vasa previa

Evaluate with doppler (weekly is not necessary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Risk factors for postpartum urinary retention

A 
Nulliparity
Prolonged labor
Instrumental delivery
Regional anesthesia (reduces sensory &amp; motor impulses from sacral spinal cord, leads to bladder atony)
Perineal trauma (pudendal nerve palsy &amp; perineal edema can lead to urinary retention)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

When to suspect postpartum urinary retention

A

Patient is unable to void 6 hours after vaginal delivery

OR

Patient is unable to void 6 hours after removal of catheter for cesarean.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How to confirm postpartum urinary retention

A

Urethral catheterization more accurate than bladder scan

Confirms retention at >= 150mL urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Treatment of postpartum urinary retention

A

Analgesia
Ambulation

If those don’t work, catheterize & reassure that retention is usually temporary and reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Postpartum decreased urine production

A

Postpartum hemorrhage can lead to renal hypoperfusion & ATN

OR

Preeclampsia can cause intense vasospasm & third spacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Breast Engorgement

A

Onset 3 - 5 days postpartum

Occurs any time there is milk accumulating
Bilateral symmetric breast fullness, tenderness, warmth
No fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Treatment of breast engorgement

A

Cold compresses
Acetaminophen
NSAIDS
Regular breastfeeding or pumping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Risk factors for abruptio placentae

A

Hypertension
Cocaine use
Maternal trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Abdominal and/or back pain late in pregnancy
Category 2 or 3 tracing
Vaginal bleeding

A

Abruptio placentae

May present with firm uterus, uterine distension (if bleeding is concealed) and low-amplitude frequent contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How often should BPPs be performed in gestational hypertension?

A

Weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

BPP reveals 6/10

A

Equivocal

Repeat in 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Definition of Small for Gestational Age

A

Weight < 10th percentile for gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Maternal factors leading to SGA infants

A 
Preeclampsia
Malnutrition
Placental Insufficiency
Multiparity
Drug Use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Fetal factors leading to SGA infants

A

Genetic Factors
Chromosomal Abnormalities
Congenital Infections
Inborn Errors of Metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

SGA infants are at risk for

A 
Hypoxia
Perinatal Asphyxia
Meconium Aspiration
Hypothermia
Hypoglycemia
Hypocalcemia
Polycythemia (a response to hypoxia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

When is it classified as Gestational Hypertension?

A

> =140 / >= 90 on 2 separate measurements at least 4h apart
New at >= 20w gestation (anything earlier is chronic)

AND

Proteinuria OR signs of end organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Maternal pregnancy risks from hypertension

A 
Superimposed Preeclampsia
Postpartum Hemorrhage
Gestational Diabetes
Abruptio Placentae
Cesarean Delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Fetal risks from maternal hypertension

A

Fetal growth restriction
Perinatal mortality
Preterm delviery
Oligohydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Acute Fatty Liver of Pregnancy

A

Nausea
Vomiting
Abdominal Pain
Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

In a patient with preeclampsia bordering on hypertensive emergency, what anithypertensives would you use?

A

IV Hydralazine
IV Labetalol (if patient is not bradycardic)
PO Nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

When do you give the quadruple screen?

A

Weeks 15 - 22

AFP
Estriol
beta-hCG
Inhibin A

69
Q

When do you offer cell free fetal DNA testing?

A

> = 10 weeks

Not diagnostic, but highly sensitive & specific

70
Q

When do you offer CVS?

A

Weeks 10 - 13

71
Q

When do you offer amniocentesis?

A

Weeks 15 - 20

72
Q

Endometriosis discovered incidentally with no symptoms

A

Observation only for now

73
Q

Treatment of Uterine Inversion

A

IV Fluid Replacement
Manual replacement of the uterus
Placental removal & uterotonic drugs (oxytocin, misoprostol)

74
Q

First stage of labor

A

From onset of regular contractions

To when patient is 10cm dilated

Contains latent phase (gradual dilation) & active phase (rapid dilation)

75
Q

No cervical change for >= 4 hours with adequate contractions

OR

No cervical change for >= 6 hours with inadequate contractions

A

Arrest of Labor

Perform cesarean delivery

76
Q 
PPROM
Maternal Fever
Maternal &amp; Fetal Tachycardia
Uterine Fundal Tenderness
Maternal Leukocytosis
A

Chorioamnionitis

77
Q

If the fetus shows signs of infection during delivery

A

Give broad spectrum antibiotics and induce

Only perform cesarean for standard indications (fetal heart tracing, breech, prior surgeries)

78
Q

Patient displays heart failure signs in pregnancy, but is overall stable

A

Reassure

79
Q

Biggest risk factor for preterm labor

A

Previous preterm delivery

80
Q 
At Delivery:
Thin, loose skin
Thin umbilical cord
Wide anterior fontanel
Meconium-stained amniotic fluid
Decreased subQ fat
A

Fetal Growth Restriction

Send placenta for histopathologic exam, looking for:
Infarction
Infection (especially spirochetes)

Send UTox & Serology, looking for:
Drugs
Infection (especially CMV, Toxo, Rubella)

If Physical Exam is syndromic, send karytoype

81
Q

Indications for cranial ultrasonography

A

Gestaional age < 30w at delivery
Respiratory distress
Hypotension

82
Q

Indications for antibiotics in the newborn

A

Fever
Tachypnea
Grunting
Lethargy

83
Q

Meconium Aspiration Syndrome

A

Respiratory distress due to inhalation of meconium-stained amniotic fluid

Give surfactant therapy

84
Q

Painless vaginal bleeding

Fetal heart rate abnormalities after amniotomy

A

Vasa Previa

85
Q

First trimester lithium use is associated with

A

Increased risk of congenital heart disease
Especially Ebstein’s anomaly

If bipolar disease is stable, consider slow taper

86
Q

Congenital abnormalities associated with Isotretinoin

A

Carniofacial Dysmorphism
Heart defects
Deafness

87
Q

Woman of reproductive age wants to start isotretinoin. What are the requirements?

A

Two effective forms of contraception have been used for at least 1 month prior to initiation

88
Q

Pathophys of Osteogenesis Imperfecta

A

Autosomal Dominant

Type 1 Collagen Defect

89
Q

Findings in Osteogenesis Imperfecta Type II

A 
Multiple fractures
Short femur
Hypoplastic thoracic cavity
Fetal growth restriction
Intrauterine demise
90
Q

Types of Osteogenesis Imperfecta

A

Mild (Type I)
Fatal Perinatal (Type II)
Moderate (Types III - IX)

91
Q

If a fetus with Osteogenesis Imperfecta Type II survives delivery, how does it die?

A

Pulmonary hypolpasia (complication of hypoplastic thoracic cavity)

Give supportive care while fetus remains alive

92
Q

Achondroplasia

A

Non-lethal
Autosomal Dominant
Bone dysplasia

93
Q

Features of Achondroplasia

A 
Macrocephaly
Frontal Bossing
Midface Hypoplasia
Genu Varum
Limb Shortening
94
Q

Limb Defects
Craniofacial Defects
Abdominal Wall Defects

A

Amniotic Band Sequence

95
Q

Paget Disease of the Bone

A

Bone metabolism disorder
Defective osteoclasts

Adult onset
Headaches, hearing loss, spinal stenosis, osteosarcoma

96
Q

Potter Sequence

A

Pulmonary Hypoplasia
Limb Deformities
Oligohydramnios

Most commonly due to Urinary Tract Abnormalities (Bilateral renal agenesis, polycystic kidney disease)

97
Q

Maternal Vitamin D Deficiency is associated with

A

Fetal Growth Restriction

98
Q

Risk factors for placenta accreta

A

History of cesarean
History of D&C
AMA

99
Q

First 6 months of the Depot Medroxyprogesterone injection method of contraception

A

Menstrual irregularities

100
Q

1 year of use of the Depot Medroxyprogesterone injection method of contraception

A

50% of women have amenorrhea at this point

101
Q

Rare side effects of the Depot Medroxyprogesterone injection method of contraception

A

Weight Gain
Fatigue
Nausea
Breast Tenderness

These symptoms are typically experienced throughout. If they are new, after the injections have been going on for a while, consider pregnancy

102
Q

Decreased fetal movements

A

Suspect fetal compromise

Proceed to NST

103
Q

When do you do routine NSTs?

A

High-risk pregnancies starting at 32 - 34 weeks

Or if mom feels less fetal movement

104
Q

Normal NST looks like

A

In 20 min there are >= 2 accelerations of at least 15 bpm above baseline, lasting 15 seconds each

105
Q

Most common cause of abnormal NST

A

Fetal sleep cycle

Awaken fetus with vibroacoustic stimulation

106
Q

Causes of uterine atony

A

Fatigue (Prolonged labor)
Overdistended (Fetal weight > 8.8 lbs)
Unresponsive to oxytocin from receptor saturation

107
Q

Risk factors for uterine atony

A

Operative vaginal delivery

Hypertensive disorders

108
Q

In pregnancy, DIC is associated with

A

Preeclampsia
Amniotic Fluid Embolism
Sepsis

109
Q

Most common cause of primary postpartum hemorrhage

A

Uterine Atony

110
Q

First line management of postpartum hemorrhage

A

Bimanual massage

Oxytocin (IV)

111
Q

If Oxytocin & massage fail to resolve postpartum hemorrhage, proceed to

A

Methylergonovine (avoid in HTN)

Carboprost (avoid in asthma)

112
Q

Normal Postpartum Findings

A 
Transient rigors/chills
Peripheral edema
Lochia rubra
Uterine contraction &amp; involution
Breast engorgement
113
Q

Routine Postpartum Care

A 
Rooming-in / Lactation support
Serial examination for uterine atony/bleeding
Perineal care
Voiding trial
Pain management
114
Q

Components of Apgar score

A 
Muscular tone (2)
Respiratory effort (2)
Heart rate (2)
Reflex irritability (2)
Pink body color (2)
115
Q

Checklist for normal baby immediately after birth

A

Clear airway secretions (suction)
Dry infant & keep warm
Erythromycin to the eyes
Vitamin K IM

116
Q

Amphetamine use during pregnancy is associated with

A

Preterm delivery
Abruptio placentae
Fetal growth restriction
Intrauterine fetal demise

117
Q

Management of pubic symphysis diastasis

A

Supportive care (pelvic support, PT)

Most patients recover within 4 weeks

118
Q

Risk of McRoberts Maneuver

A

Femoral nerve damage

119
Q

When is GBS screening most appropriate

A

3 - 5 weeks prior to delviery

Without signs of preterm labor, most screening is done at 35 - 37 weeks gestation

120
Q

Elevated fetal fibronectin < 20w gestation

A

Normal

121
Q

Elevated fetal fibronectin > 20w gestation

A

Sign of imminent labor. If it is term, whoopee!!

If it is preterm, fetus is at risk for preterm delivery.

122
Q

Pregnant patient has history of preterm delivery

A

At risk for another

Give IM progesterone starting in 2nd trimester
Serial TVUS to assess cervical lengths

If short cervix, cerclage

123
Q

Agent for ripening cervix

A

Prostaglandins

124
Q

When do we give medical induction for a spontaneous abortion (missed or inevitable)?

A

When the patient is hemodynamically stable

125
Q

How is Gabapentin excreted?

A

Renally

In pregnancy, the kidneys are working harder and dose adjustments may be necessary to maintain serum levels

126
Q

Mechanism of hypercoagulability in pregnancy

A

Decreased Protein S activity
Increased Fibrinogen
Increased resistance to Activated Protein C

127
Q

Risk factors for Hyperemesis Gravidarium

A

Multiple Gestations
Hydatidiform Mole
History of GERD

128
Q

How do you differentiate typical nausea/vomiting of pregnancy from Hyperemesis Gravidarium

A

Ketones on urinalysis = HG
Volume Status Changes = HG
Weight loss of > 5% prepregnancy weight

129
Q

Treatment of Hyperemesis Gravidarium

A

Hospital admission
IV Antiemetics
IV Fluids

130
Q

Recommended vaccines during pregnancy

A

Tdap
Inactivated influenza
RhoGAM

131
Q

Vaccines for high risk patients in pregnancy

A 
Hepatitis B
Hepatitis A
Penumococcus
H. Flu
Meningococcus
Varicella-zoster immunoglobulin
132
Q

Vaccines contraindicated in pregnancy

A

HPV
MMR
Live-attenuated influenza
Varicella

133
Q

Pregnant patient doesn’t have immunity to Rubella or Mumps

A

Give MMR postpartum

If you give it in pregnancy, fetus has a risk of congenital rubella syndrome. It is safe during breastfeeding, though.

134
Q

Congenital Rubella Syndrome

A 
Deafness
Cardiac defects
Hepatosplenomegaly
Microcephaly
Cataracts
135
Q

Fetal risks in preeclampsia

A

Abnormal placental development/function:

Uteroplacental insufficiency leads to oligohydramnios & growth restriction/low birth weight, even at full term

136
Q

Contraindications to breastfeeding

A 
Active untreated TB
Maternal HIV infection
Herpetic breast lesions
Active varicella infection
Chemotherapy or radiation therapy
Active substance abuse

If the infant has galactosemia

137
Q

Sinusoidal fetal heart tracing

A

Fetal anemia

138
Q

Early decelerations

A

Shallow decreases in fetal heart rate
Mirror uterine contraction

Response to increased ICP

139
Q

Variable decelerations

A

Abrupt drops in fetal heart rate
Varying depth and duration

Compression of umbilical cord leads to transient fetal hypertension & parasympathetic bradycardic response

140
Q

Adverse effects of Oxytocin

A

Hyponatremia (Oxytocin is like Vasopressin)
Hyoptension
Tachysystole (abnormally frequent contractions)
Tetanic contractions

141
Q

Treatment for recurrent variable decelerations

A 
Maternal repositioning (left lateral)
Amnioinfusion if that doesn't work
142
Q

Follow up after abnormal prenatal screening test

A

CVS if early (10 - 13 weeks)

Amniocentesis if late (15 - 20 weeks)

143
Q

Treatment for Gestational Diabetes

A

Dietary modifications & exercise
Insulin
Glyburide & metformin work too

144
Q

Diabetes drugs not used in pregnancy

A

Sulfonylureas (chlorpropamide, tolbutamide) cross the placenta
Thiazoledinediones had adverse effects in animal models

145
Q

Management of shoulder dystocia

A

BE CALM

Breathe (do not push)
Elevate legs &amp; flex hips, thighs against abdomen (McRoberts)
Call for help
Apply suprapubic pressure
enLarge vaginal opening with episiotomy
Maneuvers
146
Q

Maneuvers for shoulder dystocia

A

Deliver posterior arm
Rotate posterior shoulder (Woods screw), apply pressure to anterior aspect of posterior shoulder
Adduct posterior fetal shoulder (Rubin), apply pressure to the posterior aspect of the posterior shoulder
Mother on hands & knees, “all fours” (Gaskin)
Replace fetal head into pelvis for cesarean delivery (Zavanelli)

147
Q

Patient presents with false labor at 35 weeks

A

Reassure, send her home

148
Q

What happens to the uterus if mom goes into hemorrhagic shock?

A

Blood is shunted AWAY from uterus.

You may see absence of accelerations on fetal heart tracing.

149
Q

Mom goes into hemorrhagic shock due to abruptio placentae

A

Fluid resuscitate her with crystalloids
Place her in LLD position

Transfuse her only if she doesn’t respond to fluids

150
Q

Why don’t we give tocolytics for premature labor >=34 weeks?

A

Indomethacin - Increased risk of oligohydramnios & closure of the ductus arteriosus

Nifedipine - Increased risk of maternal hypotension/tachycardia

These risks outweigh risks of premature labor

Since we don’t give tocolytics at this point, premature labor will likely progress. Give betamethasone & penicillin (if GBS+ or unknown)

151
Q

Vaginal delivery in a singleton breech fetus

A

Contraindicated. Do a C-section.

152
Q

External cephalic version in active labor

A

Relatively contraindicated. Don’t try it. Do a C-section if the baby is breech.

153
Q

Reactive NST has high negative predictive value to rule out

A

Fetal acidemia

154
Q

Nonreactive NST

A

High false positive rate
Low positive predictive value
Cannot rule in fetal acidemia

Evaluate further with BPP or CST

155
Q

Contraindications to Contraction Stress Test (CST)

A

Contraindications to labor:
Placenta previa
Prior myomectomy

Do a BPP instead, in these patients.

156
Q

BPP score of 0 - 4

A

Fetal hypoxia due to placental dysfunction

157
Q

Risk factors for placental insufficiency

A

AMA
Tobacco use
Hypertension
Diabetes

158
Q

Management of Fetal Growth Restriction

A

Weekly BPPs
Serial umbilical artery Dopplers
Serial growth ultrasounds

159
Q

Recommendations when previa is diagnosed

A

Pelvic rest

160
Q

In abruptio placentae, the larger the placental detachment, the greater the risk of

A

DIC (from tissue factor released by decidual bleeding)
Hypovolemic shock
Fetal hypoxia
Preterm delivery

161
Q

Liver pathology in HELLP Syndrome

A

Centrilobular necrosis
Hematoma formation
Thrombi in portal capillary system

These lead to swelling & distension of Glisson’s capsule, resulting in RUQ or epigastric pain.

162
Q

Diagnosis of Antiphospholipid Syndrome

A

Thrombosis (TIA/Stroke/DVT) & Pregnancy complication (recurrent miscarriage)

PLUS

> =1 of the following:
Anti-cardiolipin Ab
Lupus anticoagulant
Anti-beta2-glycoprotein antibody

163
Q

Treatment for Antiphospholipid Syndrome

A

Anticoagulation (LMWH in pregnancy, Warfarin long term)

164
Q

Treatment of preterm labor < 34w

A 
Tocolytics (Indomethacin, nifedipine)
Corticosteroids (Betamethasone)
Magnesium Sulfate (if <32w) to lower risk of CP
165
Q

Magnesium Sulfate (outside of preeclampsia use)

A

Weak tocolytic

Used mainly in premature labor for fetal neuroprotection <32 weeks expected to deliver within the next 24 hours

166
Q

Late-term & Postterm Fetal Complications

A 
Oligoydramnios
Meconium aspiration
Stillbirth
Macrosomia
Convulsions
167
Q

Late-term & Postterm Maternal Complications

A

Cesarean delivery
Infection
Postpartum hemorrhage
Perineal trauma

168
Q

Late term pregnancy with oligohydramnios but all other fetal testing is normal

A

Deliver! Oligo suxxxx!

169
Q

Pregnant patients who are underweight or don’t gain appropriately are at risk of

A

Fetal growth restriction

Preterm delivery

Mistakes (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions